Clinical Correlates of Alcohol Use Disorder in Depressed Patients with Unipolar and Bipolar Disorder

Alcohol use history increases the likelihood of suicide behavior among male chronic patients with schizophrenia in a Chinese population

AIMS

This study was designed to detect the association between the history of alcohol drinking and suicidality in schizophrenia (SCZ) inpatients in a Chinese population.

METHODS

We recruited 616 male SCZ inpatients and collected demographic and clinical data. Five-factor model of the Positive and Negative Syndrome Scale (PANSS) was used to assess their psychopathological symptoms.

RESULTS

Our results showed that 31.33% of SCZ patients had a history of alcohol drinking. They had higher rates of lifetime suicide attempt and suicidal ideation than those without a history of alcohol drinking. Moreover, patients with a history of drinking were more likely to attempt suicide (14.51% vs. 7.09%; χ²  = 7.70, df = 1, p = 0.006), with an odds ratio (OR) of 2.22 and have suicidal ideation (29.02% vs. 17.49%; χ²  = 9.89, df = 1, p = 0.002), with an OR of 1.93. In addition, patients who used to drink alcohol were more likely to be smokers and had more severe positive and depressive symptoms (all p < 0.05).

CONCLUSIONS

Our study indicates that history of alcohol drinking may increase the prevalence of lifetime suicide attempt and suicidal ideation in male patients with chronic SCZ. Moreover, the history of alcohol drinking may be associated with some demographic data and clinical symptoms.

Geographical Variation in Mental Hospital Discharges in Greece: A Nationwide Study (1999–2012)

Background: The primary goal of this study is to estimate the pattern of hospital discharges throughout Greece due to mental disorders between 1999 and 2012. Methods: Data for discharges were obtained from the Hellenic Statistical Authority. A sex- and age-adjusted proportional hospitalization ratio (PHR) was used to estimate the ratio between the hospitalizations in each prefecture and the overall hospitalizations. Additionally, age-adjusted admission rates and hospitalization days were calculated for each sex. Descriptive and time series analysis were conducted to understand the epidemiological characteristics and to investigate the trend of annual PHR, respectively. Correlation between disorders and sociodemographic characteristics was also tested. Global and local spatial analysis was conducted to assess the spatial homogeneity of disorders and to detect any clusters of similar values. Results: More males (55%) were hospitalized. Schizophrenic and other psychoses were stated as the primary diagnosis of discharges (54.3%) for mental disorders, contributing to the highest annual mean number of hospitalization-days for male (296.9) and female patients (341.0). Most patients were out of the workforce, and most patients with drug dependence (74.5%) and schizophrenia and other psychoses (55.9%) remained unmarried. Higher PHRs were discovered in the north, while schizophrenic and other psychoses (R = 0.492), affective psychoses (R = 0.534), senile and presenile organic psychotic conditions (R = 0.543) were correlated with alcohol consumption (p < 0.001). Conclusions: The study provides evidence of geographical variation of discharges due to mental disorders and a significant association between disorders and alcohol consumption, marriage status and absence of the workforce.

Effect of vortioxetine in subjects with major depressive and alcohol use disorders: a 6-month retrospective analysis

BACKGROUND

Major depressive disorder (MDD) and alcohol use disorder (AUD) are highly comorbid, with greater clinical complexity and psychosocial impairment. Several antidepressants have been used in this population, with mixed results. This preliminary study aims to investigate the effects of the multimodal antidepressant vortioxetine in MDD + AUD subjects.

METHODS

We retrospectively evaluated 57 MDD + AUD and 56 MDD outpatients, matched for baseline characteristics. Patients were assessed after 1, 3, and 6 months treatment with vortioxetine (10-20 mg/d, flexibly dosed) in combination with continuous psychosocial support. The primary outcome was improvement in depressive symptoms measured by the Montgomery-Åsberg Depression Rating Scale. We also investigated changes in anxiety, anhedonia, cognition, functioning, quality of life, and clinical global severity using the following instruments: Hamilton Anxiety Rating Scale, Snaith-Hamilton Pleasure Scale, Digit Symbol Substitution Test, Perceived Deficits Questionnaire-Depression, Functioning Assessment Short Test, Quality of Life Index, and Clinical Global Impression-Severity Scale.

RESULTS

Vortioxetine significantly improved mood in MDD + AUD patients (P < .001), with no differences when compared to MDD (P = .36). A substantial rate (45.6%) of comorbid subjects obtained clinical remission at endpoint (P = .36 vs MDD). We additionally observed baseline to endpoint improvements on all secondary outcomes (P < .001), with no significant difference between groups. Overall, vortioxetine was safe and well tolerated.

CONCLUSIONS

Given its effectiveness on mood, cognition, and functioning, its good safety and tolerability profile, and low potential for abuse, vortioxetine could represent a valid pharmacological intervention in MDD + AUD patients as part of an integrated therapeutic-rehabilitation program.

Affective Temperaments and Illness Severity in Patients with Bipolar Disorder

Background and objectives: Bipolar disorder (BD) is one of the most burdensome psychiatric illnesses, being associated with a negative long-term outcome and the highest suicide rate. Although affective temperaments can impact on BD long-term outcome, their role remains poorly investigated. The aims of the present study are to describe the clinical characteristics of patients with BD more frequently associated with the different affective temperaments and to assess the relation between affective temperaments and severity of clinical picture in a sample of patients with BD. Materials and Methods: A total of 199 patients have been recruited in the outpatients units of two university sites. Patients’ psychiatric symptoms, affective temperaments, and quality of life were investigated through validated assessment instruments. Results: Predominant cyclothymic and irritable temperaments are associated to higher number of relapses, poorer quality of life, higher rates of aggressive behaviors, and suicide attempts. Conversely, the predominant hyperthymic disposition was a protective factor for several outcome measures, including relapse rate, severity of anxiety, depressive and manic symptoms, suicidality, and earlier age at onset. One limitation of the present study is that the recruitment took place in two university sites; therefore, our findings cannot be fully generalized to the whole community of BD patients. Other limitations are the lack of a control group and the cross-sectional design of the study. Conclusions: The early identification of affective temperaments can help clinicians to identify those BD patients who are more likely to show a poor long-term outcome. An early screening of affective temperaments can be useful to develop targeted integrated pharmacological and psychosocial interventions.

Alcohol Use Disorder and Its Associate Factors Relating to Patients with Severe Mental Disorders Attending Psychiatric Follow-Ups in Northwest Ethiopia

BACKGROUND

Patients with mental disorders have high rates of co-existing alcohol use disorder and vice versa. Alcohol use disorder has emerged as a major challenge to intervene patients with severe mental disorders. It is under-recognized and has not been investigated well in low-income countries like Ethiopia. The aim of this study was to assess the prevalence and associate factors of alcohol use disorder among patients with severe mental disorders attending psychiatric follow-ups at the University of Gondar comprehensive specialized hospital, northwest Ethiopia.

METHODS

A total of 384 patients with severe mental disorders selected by a systematic random sampling technique took part in the interviews for this cross-sectional study. The alcohol use disorder identification test was used to assess the problem. Univariate and multivariate binary logistic regressions were computed to examine the associated factors. An adjusted odds ratio with a 95% confidence interval (CI) was used for reporting the result.

RESULTS

The prevalence of alcohol use disorder among patients with severe mental disorders was 36.2%. Of the participants, 23.5%, 8.6%, and 4.1% had hazardous, harmful alcohol drinking and alcohol dependency, respectively. In the multivariate analysis, male sex, younger age, psychotic and bipolar disorder diagnoses, having poor social support, moderate and high perceived stress, and current tobacco smoking were factors significantly associated with alcohol use disorder.

CONCLUSION

The prevalence of alcohol use disorder among patients with severe mental disorders was found to be high. Early intervention and integrating treatment services for co-existing mental disorders and alcohol use disorder is important. The special treatment, where it is offered for young male patients and those with the diagnosis of psychotic and bipolar disorders, is recommended to promote the uptake of alcohol and mental health treatment services.

Depression and substance use disorders: Clinical comorbidity and shared neurobiology

Mood disorders, including major depressive disorder (MDD), are the most prevalent psychiatric illnesses, and pose an incredible burden to society, both in terms of disability and in terms of costs associated with medical care and lost work time. MDD has extremely high rates of comorbidity with substance use disorders (SUD) as many of the same neurobiological circuits and molecular mechanisms regulate the reward pathways disrupted in both conditions. MDD may induce SUDs, SUD may contribute to MDD development, or underlying vulnerabilities and common life experience may confer risk to developing both conditions. In this chapter we explore theories of MDD and SUD comorbidity, the neurobiological underpinnings of depression, overlapping cellular and molecular pathways for both conditions, and current treatment approaches for these comorbid conditions.

Association of Alcohol Intake and Fracture Risk in Elderly Varied by Affected Bones: A Nationwide Longitudinal Study

OBJECTIVE

Previous studies investigating association of alcohol intake and fracture risk in elderly yielded conflicting results. We first examined the association between alcohol intake and total fracture risk in elderly subjects and further analyzed whether the association varied by fracture locations.

METHODS

This is a nationwide population-based cohort study which included all people aged 66 (n=1,431,539) receiving the National Screening Program during 2009-2014. Time-to-event were defined as duration from study recruitment, the day they received health screening, to the occurrence of fracture.

RESULTS

Total fracture was significantly lower in mild drinkers [adjusted hazard ratio (aHR)=0.952; 95% confidence interval (95% CI) =0.931-0.973] and higher in heavy drinkers (aHR=1.246; 95% CI=1.201-1.294) than non-drinkers. Risk pattern of alcohol consumption and fracture differed according to affected bones. Similar J-shaped trends were observed for vertebra fractures, but risk of limb fracture showed a linear relationship with alcohol intake. For hip fracture, risk decrement was more pronounced in mild and moderate drinkers, and significant increment was noted only in very severe drinkers [≥60 g/day; (aHR)=1.446; 1.162-1.801].

CONCLUSION

Light to moderate drinking generally lowered risk of fractures, but association between alcohol and fracture risk varied depending on the affected bone lesions.